Provider Demographics
NPI:1104881663
Name:KOEN, TOMMY J (DMD)
Entity type:Individual
Prefix:DR
First Name:TOMMY
Middle Name:J
Last Name:KOEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:131 INDIAN LAKE BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37045
Mailing Address - Country:US
Mailing Address - Phone:615-824-5636
Mailing Address - Fax:615-824-5707
Practice Address - Street 1:131 INDIAN LAKE BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37045
Practice Address - Country:US
Practice Address - Phone:615-824-5636
Practice Address - Fax:615-824-5707
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN41131223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics